Healthcare Provider Details

I. General information

NPI: 1356469522
Provider Name (Legal Business Name): CHHEANY WALTER UNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 OGDEN RD
ROANOKE VA
24018-8200
US

IV. Provider business mailing address

3405 OGDEN RD
ROANOKE VA
24018-8200
US

V. Phone/Fax

Practice location:
  • Phone: 540-777-0090
  • Fax: 540-206-3826
Mailing address:
  • Phone: 540-777-0090
  • Fax: 540-206-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD428672
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0101242119
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: